Changes in physical activity and sleep habits among adults in Russian Federation during COVID-19: a cross-sectional study
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Kontsevaya et al. BMC Public Health (2021) 21:893
https://doi.org/10.1186/s12889-021-10946-y
RESEARCH Open Access
Changes in physical activity and sleep
habits among adults in Russian Federation
during COVID-19: a cross-sectional study
Anna V. Kontsevaya1*, Dinara K. Mukaneeva1, Azaliia O. Myrzamatova1, Anthony D. Okely2 and Oxana M. Drapkina1
Abstract
Background: The aim of this study was to evaluate the impact of COVID-19 on the levels of physical activity (PA)
and sleep and to examine specific COVID-19 factors that may be associated with changes in PA and sleep among
adults in Russia.
Methods: Cross-sectional data were collected during the period of tightest restrictions between 26 April 2020 and
6 June 2020. Eligible participants included all Russian adults aged 18 years and over. Participants reported their
sleep patterns and problems, frequency and duration of walking, moderate- and vigorous-intensity PA, and muscle
strengthening activities before COVID-19 and during the past 7 days. Access to an outdoor green space and fitness
centres, use of online resources, adherence to self-isolation recommendations and other preventive measures from
Ministry of Health were self-reported.
Results: The sample included 2432 participants from 62 regions, 83% of who were female. There was a significant
decline in the number of days per week participants reported not getting enough sleep (3.21 ± 2.44 to 2.86 ± 2.57;
P < 0.001); participants also reported an increase in the number of days per week they had trouble falling asleep
(1.70 ± 2.24 to 2.13 ± 2.48; P < 0.001). The proportion of participants who met the WHO Guidelines for PA declined
from 68 to 49% (P < 0.001). The proportion who participated in muscle strengthening activities for 2 or more days
per week declined from 53 to 45% (P < 0.001).
Conclusion: Compared with before COVID-19, PA and sleep hygiene were adversely affected during COVID-19.
Awareness of factors associated with these declines will assit policymakers in developing strategies to mitigate the
negative lifestyle behaviours that have manifested during the COVID-19 confinement.
Keywords: Movement behaviours, Pandemic, Environments, Adults, Russia
* Correspondence: koncanna@yandex.ru
1
Department of Public Health Promotion, National Medical Research Centre
for Therapy and Preventive Medicine of the Ministry of Health of Russia, Bld.
10, Petroverigskiy Lane, Moscow 101990, Russia
Full list of author information is available at the end of the article
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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.Kontsevaya et al. BMC Public Health (2021) 21:893 Page 2 of 12
Key-points decrease in PA levels in April 2020 compared with be-
fore COVID-19 [10]. Negative changes in PA were asso-
1. Compared with before COVID-19, physical activity ciated with higher depression, anxiety and stress
and sleep habits were adversely affected during symptoms in this study. An international survey of PA
COVID-19. including 1000 adults from Europe, Africa, Asia and the
2. Awareness of factors associated with these declines Americas showed that home confinement during the
will assit policymakers in developing strategies to pandemic had a negative effect on all PA intensity levels
mitigate the negative lifestyle behaviours that have [11]. Sitting (measured in hours/day) increased by 28.6%,
manifested during the COVID-19 confinement. Vigorous intensity PA decreased by 22.7%, and the num-
3. Effective health promotion strategies directed at ber of days/week of walking decreased by 35% [11]. In
adopting or maintain positive health-related behav- Spain, participants reduced their weekly PA levels by
iours such as targeted social media messaging and 20% (~ 45.2 weekly minutes) during the first week of
balanced media reporting, should be used to reduce confinement compared with the previous week and the
participant burden during these unprecedented proportion who met the WHO guidelines decreased
times. from 61 to 49% [12]. In Greece, a survey of 8495 adults
found that time spent in daily occupational activity, ac-
Background tive transport, and sporting activities reduced substan-
Physical activity (PA) is an important determinant of tially, with overall PA decreasing by 16% [13]. In the
health [1], and is associated with all-cause mortality [2], United Kingdom, a survey involving 723 adults during a
risk of cardiovascular diseases and diabetes [3]. In No- week of lockdown in April 2020 found that although
vember 2020 the World Health Organization (WHO) is- 35% reported exercising less during COVID than before,
sued updated guidelines which recommend the amount 49% reported exercising more than before [14]. These
of PA necessary to maintain health. These guidelines results were similar when the study was extended to a
recommend that adults should be engaged in 150 min of larger sample (N = 2002) and prolonged until the 22nd
moderate PA or 75 min of vigorous PA per week [4]. of May with 40% reporting a decrease in PA, and 45%
This recommendation is confirmed by systematic re- an increase in PA [15]. In an earlier global study, 19.1
views and meta-analyses of studies which show that million daily step count measurements were provided by
meeting the WHO guidelines resulted in significant re- 455,404 unique users from 187 countries, within 10 days
duction of cardiovascular events risk, cardiovascular of the pandemic declaration. There was a 5.5% decrease
mortality, and incidence of type 2 diabetes [5]. The pro- in mean steps (287 steps), and within 30 days, there was
portion of adults in Russia who meet the WHO PA a 27.3% decrease in mean steps (1432 steps) [16].
guidelines is only 30% [4], a figure not dissimilar with Several studies have investigated the association be-
global rates [6]. tween COVID-19 and changes in sleep habits, includ-
The outbreak of novel coronavirus (COVID-19) in late ing sleep duration and perceptions of sleep quality. In
December 2019 in China, and subsequent declaration by the Spanish study described above the percentage of
the WHO as a global pandemic in March 2020 [7] adults who slept for fewer than 6 h per day decreased
forced countries to implement strict hygiene regimes [17]. In Jordan, it was reported that anxiety and de-
and social distancing measures. Extensive social distan- pression during lockdown were associated with poorer
cing policies were put into place restricting people’s sleep quality and shorter sleep duration [18]. A study
daily activities. While these restrictions helped slow the of nearly 1000 participants in India found that com-
rate of infection, there may be concomitant negative ef- pared to before lockdown, adults were going to bed
fects as a result of limiting participation in normal daily and waking up later, sleeping less at night, and nap-
activities such as walking and cycling for transport and ping more during the day [19].
leisure and access to many types of recreational activities The Russian Federation has reported one of the largest
such as team sports, gyms, fitness centers, and dancing number of COVID-19 infections (https://epidemic-stats.
classes. com/) [20]. Social distancing, travel bans, the
Several studies have shown the impact of COVID-19 cancellation of sporting and other mass participation
on healthy levels of PA, sedentary behaviour (SB) and events, and changes to work practices have dramatically
sleep, collectively referred to as 24-h movement behav- affected daily life throughout the country. Major restric-
iours [8]. A recent systematic review which included 13 tions were introduced on the 28th March 2020 with the
PA and 26 SB studies found that all studies reported de- level of restrictions varied depending on the epidemi-
creases in PA and increases in SB, respectively, from be- ology of the virus from region to region. Cities with a
fore to during COVID-19 [9]. An Australian survey of large number of cases had the strictest restrictions, such
1500 participants found that nearly half reported a as limitations on any outdoor activities. Further, citizensKontsevaya et al. BMC Public Health (2021) 21:893 Page 3 of 12
were required to possess an electronic pass to leave their sources including email and public marketing. To in-
house and this was only permitted for workers during crease regional participation a link to the electronic sur-
work hours, and to access essential services such as vey was send to the chief specialist in public health and
medical or health care, to shop for groceries, or to visit preventive medicine in regional Ministries of Health
parks and green zones (excluding outdoor activities en- who then distributed it at regional levels in Russia via a
tirely). In cities with a smaller number of cases, limita- range of methods such as a shared link on the official
tions were less strict especially with outdoor activities. web-pages and social media of regional Centers for pub-
Indoor sport activities were limited across the country lic health and medical prevention and on regional Minis-
and outdoor sports were restricted – depending on the tries of Health official web pages. The general public was
situation in the region. Social distancing measures such asked to promote survey across their personal networks.
as keeping a minimum 1.5 m between people were intro- The starting page of the survey informed participants
duced, as well as a ban on any public gatherings of more about the aims and details of the survey. This method of
than 50 people. On-line learning for schools and univer- data collection provides data from a convenience sample
sities and recommendations for remote working for em- and whose population parameters cannot be controlled
ployees were introduced. as is the case for probabilistic sampling. However, it was
In the Russian Federation, population levels of PA are effective with respect to the research objectives because
sub-optimal [21, 22]. This low prevalence of adequate it allowed the broad dissemination of the survey during
PA is a main contributing factor to the high prevalence a period where, due to COVID-19, there were many re-
of overweight and obesity [23]. In addition, the preva- strictions on the collection of such data.
lence of adequate sleep (defined by the US CDC and Na- Eligible participants included all Russian adults aged
tional Sleep Foundation as 7–9 h per night for adults) 18 years and over. Data collection occurred between 26
was only 37% [24]. However, the relationship between April 2020 and 6 June 2020. This was the period of
COVID-19 and perceived changes in PA and sleep is not tightest restriction through the country, as from the 9th
known. June 2020 there was a gradual releasing of restrictions
This study provides the first known data on the depending on the regional context.
changes in PA and sleep habits during the period of
COVID-19 among adults in the Russia Federation. Given Survey development
the size of Russia, it was important to examine how The online survey was designed by a steering group at
these behaviours changed at a national level, given the the National Medical Research Center for Therapy and
variability in restrictions across regions. Preventive Medicine of the Ministry of Health of Russia.
The aim of this study was to examine the associated Existing COVID-19 surveys from Canada, China, and
between COVID-19 and changes in levels of PA and the United Kingdom were used to inform development
sleep and to examine specific COVID-19 factors that of the survey.
may be related to changes in PA and sleep among adults A 7-day self-report recall measure was selected as a
in Russia. method for PA assessment. Since the study was con-
The research questions were: ducted during the challenging time of the pandemic-
related lockdown, PA assessment was simplified to avoid
(1) To what extent has PA and sleep changed as a the negative effect of the length of the questionnaire and
result of the COVID-19 restrictions? its complexity on the response rate [25, 26].
(2) What COVID-19 factors were associated with these The questionnaire contained 30 items and included
changes in PA and sleep? mostly close-ended questions. Section 1 consisted of 10
general and context-related questions regarding demo-
Methods graphic data and following self-isolation recommenda-
Study design and population tions. Section 2 was designed to assess PA and sleep
The National Medical Research Center for Therapy and habits before COVID-19 and in the last 7 days during
Preventive Medicine of the Ministry of Health of Russia the pandemic. Section 3 evaluated how participants
(specifically the group of authors for this paper and an followed the COVID-19 preventive measures recom-
international co-author) conducted a national online- mended by the Ministry of Health. Questions in Section
survey titled “Study of the impact of restrictions on PA 2 were presented in a differential format, to be answered
of the population in self-isolation due to COVID-19.” directly in sequence regarding “before” and “during”
An anonymous online survey was hosted on a Google confinement conditions. The full version of the ques-
online survey platform. A link to the electronic survey tionnaire is available in the Supplementary file.
was distributed using social media sources (Facebook, PA was assessed using eight items. Briefly, participants
Vkontakte and Odnoklassniki) and via institutional were asked to report, for before COVID and during theKontsevaya et al. BMC Public Health (2021) 21:893 Page 4 of 12
past 7 days, the number of days per week and the Crude estimates and estimates adjusted for gender were
amount of time per day spent in vigorous-intensity activ- reported with 95% Confidence Intervals (CI). Logistic re-
ities, moderate-intensity activities, muscle-strengthening gression was used to test which factors had impact on
activities, calisthenic-type activities, and in walking. meeting the PA recommendations (both muscles
Total PA was calculated according to the WHO guide- strengthening activities and minutes per week in MPA
lines [4]: ≥150mins/week MPA or ≥ 75mins/week VPA and VPA). Binary logistic regression analyses were con-
or combination of MVPA, muscle strength activities ≥2 ducted to investigate the association between categorical
days/week. To calculate the proportion who met the first (dependent) and continuous or categorical (independent)
recommendation, we first calculated the number of mi- variables. For these analyses ‘meeting PA Recommenda-
nutes per week spent in vigorous-intensity activity, tion (150mins/week MPA or 75mins/week VPA)’ and
moderate-intensity PA and walking by multiplying the ‘meeting muscle-strengthening activities recommenda-
number of days spent in each of these activities by the tion (≥2 days/week)’ were specified as the dependent
time usually spent doing them. For the muscle strength- variables, and followed self-isolation recommendations,
ening, we added together the number of days of strength had access to outside/green zone, had an increase in the
training and the number of days participating in basic number of days per week with sleep problems, used
calisthenic exercises (such as stretching, Zumba, yoga, digital or online PA resources, followed at least two rele-
pilates, Tai Chi) were undertaken. vant preventive measures from Ministry of Health, and
For sleep habits and perceptions of sleep quality, par- geographic location were specified as independent vari-
ticipants reported, for before COVID and in the past 7 ables. All variables in analysis for adjusted for age and
days, if they they felt they were getting enough sleep, if sex. Statistical significance was set a priori at P < 0.05.
they had trouble falling asleep, and if they woke up earl-
ier than they wanted. Results
The characteristics of the study sample are presented in
Data privacy and consent of participation Table 1. A total of 2540 participants from 62 regions
During the informed consent process, survey partici- commenced the survey with 18 participants (0.7%) fail-
pants were assured all data would be used only for re- ing to complete and their data not being used in the
search purposes. Participants’ answers were anonymous analyses. Of the 2432 participants who completed the
and confidential according to Google’s privacy policy survey, 83% were females. Compared with males, females
(https://policies.google.com/privacy?hl=en). Participants tended to be older, married, have children under 18 liv-
were not permitted to provide their names or contact in- ing with them, and in full-time employment, less likely
formation. Additionally, participants were able to stop to have completed higher education, and more likely to
participation and leave the questionnaire at any stage be- follow self-isolation recommendations. In terms of em-
fore the submission process; if they chose to do so their ployment status, 1714 (70.5%) participants had a full-
responses were not saved. Responses were saved only by time job, 399 (16.4%) were students, 65 (2.7%) were un-
clicking on the “submit” button at the end of the survey. employed, and 47 (1.9%) were retired.
By completing the survey, participants acknowledged During the COVID-19 period, most participants com-
their voluntary consent to participate in this anonymous pletely or partially followed the self-isolation recommen-
study. This study was approved by the Ethics Committee dations (n = 2160, 88.8%). The preventive measures
of the National Medical Research Center for Therapy followed most frequently were “wash hands more often”
and Prevention of the Ministry of health of Russian (90.3%) and “maintain social distancing” (79.7%). Over
Federation. 90% of participants still had access to outdoor areas and
70% had access to a green space during the restriction
Statistical analyses period. Two-thirds of participants reported that COVID-
Descriptive statistics 19 affected their PA, mostly as a result of their fitness
Descriptive statistics, including frequencies and percent- centre closing, of not being able to leave the house and
ages, were generated for categorical variables; means and of being able to undertake only simple calisthenic exer-
standard deviations (SD) were generated for continuous cises at home. One-third of participants reported using
variables. Data were analyzed in SPSS 20 (SPSS Inc., online PA resources to help them be active, during this
Chicago, IL, USA). Normality of the data distribution period.
was examined using the Kolmogorov-Smirnov test. Changes in sleep and PA from pre-COVID to during
COVID are reported in Table 2. There was a significant
Linear and logistic regressions decline in the number of days per week participants re-
Linear regression was used to test the associations be- ported not getting enough sleep (3.21 ± 2.44 to 2.86 ±
tween changes in PA and selected COVID-19 factors. 2.57; P < 0.001) and participants also reported anKontsevaya et al. BMC Public Health (2021) 21:893 Page 5 of 12
Table 1 Sample characteristics
Male (n = 328) Female (n = 2104) All (n = 2432)
Age (Mean, SD) 33.6 ± 14.9 38.2 ± 13.1 37.6 ± 13.4
Marital status, n (%)
Married 145 (48.3) 1267 (64.2) 1412 (62.1)
Single 133 (44.3) 453 (23.0) 586 (25.8)
Divorced 19 (6.3) 178 (9) 197 (8.7)
Widow/widower 3 (1.0) 75 (3.8) 78 (3.4)
Live in urban area, n (%) 243 (74.1) 1482 (70.4) 1725 (70.9)
Have children under 18 living with them, n (%) 101 (30.8) 925 (44.0) 1026 (42.2)
Higher Education completion, n (%) 181 (55.2) 964 (45.8) 1145 (47.1)
Full-time employment status, n (%) 197 (60.1) 1517 (72.1) 1714 (70.5)
Followed self-isolation recommendation (completely or partially), n (%) 262 (79.9) 1898 (90.2) 2160 (88.8)
Current area of residence, n (%)
City 243 (74.1) 1482 (70.4) 1725 (70.9)
Village 84 (25.6) 609 (28.9) 693 (28.5)
Type of residence, n (%)
Mansion, Townhouse 85 (25.9) 635 (30.2) 720 (29.6)
Flat, Hostel 239 (72.9) 1457 (69.2) 1696 (69.7)
Own a pet dog, n (%) 73 (22.3) 570 (27.1) 643 (26.4)
Access to outdoors, n (%) 288 (87.8) 1932 (91.8) 2220 (91.3)
Access to a “green space”, n (%) 219 (66.8) 1486 (70.6) 1705 (70.1)
Use digital/online physical activity resources, n (%) 98 (29.9) 764 (36.3) 862 (33.6)
How COVID-19 affected your physical activity, n (%)
No effect 107 (32.6) 717 (34.1) 824 (33.9)
Fitness centre was closed 97 (29.6) 380 (18.1) 477 (19.6)
Could not leave house 71 (21.6) 453 (21.5) 524 (21.5)
I started participating in basic calisthenic exercisesa 49 (14.9) 418 (19.9) 467 (19.2)
I started using a home exercise bike or treadmill 30 (9.1) 163 (7.7) 193 (7.9)
Other 57 (17.4) 329 (15.6) 386 (15.9)
What COVID-19 measures were followed, n (%)
Wash hands more often 286 (87.2) 1909 (90.7) 2195 (90.3)
Avoid touching face 209 (63.7) 1479 (70.3) 1688 (69.4)
Avoid traveling 211 (64.3) 1580 (75.1) 1791 (73.6)
Maintain social distancing 260 (79.3) 1679 (79.8) 1939 (79.7)
Self-isolation 262 (79.9) 1898 (90.2) 2160 (88.8)
a
This was defined as exercises such as stretching, Zumba, yoga, Pilates, and Tai Chi
increase in the number of days per week they had The proportion of participants who met the WHO
trouble falling asleep (1.70 ± 2.24 to 2.13 ± 2.48; P < Guidelines for any type of PA declined from 68 to 49%
0.001). All PA outcomes declined significantly from pre- (P < 0.001). The proportion who participated in muscle
to during COVID. The average time spent in MPA and strengthening activities for 2 or more days per week de-
VPA each declined by around 12 min per day (42.43 ± clined from 53 to 45% (P < 0.001).
37.57 to 30.44 ± 35.35 and 37.79 ± 37.80 to 26.56 ± 34.69, Associations between changes in days and time spent
respectively [all P < 0.001]). The number of minutes per in PA and sleep habits and selected COVID-19 factors
day spent walking decreased by around 20 min from are reported in Table 3. Factors consistently associated
60.5 ± 38.66 to 40.83 ± 38.6 (P < 0.001). with a greater decline in minutes per week spent inKontsevaya et al. BMC Public Health (2021) 21:893 Page 6 of 12
Table 2 Changes in sleep and physical activity from pre- to during COVID-19
Males Females Total
Pre- During P-value Pre-COVID During P-value Pre-COVID During P-value
COVID COVID COVID COVID
Number of days per week not getting enough 2.88 ± 2.66 ± < 0.001 3.26 ± 2.45 2.9 ± 2.57 < 0.001 3.21 ± 2.44 2.86 ± < 0.001
sleep (M, SD) 2.39 2.56 2.57
Number of days per week having trouble falling 1.74 ± 2.14 ± < 0.001 1.7 ± 2.23 2.13 ± < 0.001 1.7 ± 2.24 2.13 ± < 0.001
asleep sleep (M, SD) 2.32 2.54 2.47 2.48
Number of days per week waking up earlier 2.65 ± 2.45 ± < 0.001 2.62 ± 2.62 2.62 ± 2.6 0.905 2.6 ± 2.62 2.59 ± 2.6 0.505
than wanted (M, SD) 2.64 2.61
Days per week engaged in MPA 3.4 ± 2.47 ± < 0.001 2.92 ± 2.44 2.1 ± 2.32 < 0.001 2.99 ± 2.44 2.15 ± < 0.001
2.39 2.38 2.33
Average time per day spent in MPA, mins 52.5 ± 37.59 ± < 0.001 40.87 ± 29.32 ± < 0.001 42.43 ± 30.44 ± < 0.001
38.5 37.59 37.18 34.87 37.57 35.35
Days per week engaged in VPA 2.6 ± 2.03 ± < 0.001 2.18 ± 2.19 1.74 ± < 0.001 2.24 ± 2.21 1.78 ± < 0.001
2.29 2.25 2.18 2.19
Average time per day spent in VPA, mins 48.98 ± 32.88 ± < 0.001 36.05 ± 25.57 ± < 0.001 37.79 ± 26.56 ± < 0.001
40.81 37.53 37.01 34.13 37.80 34.69
Days per week spending walking (M, SD) 5.22 ± 3.58 ± < 0.001 5.37 ± 2.09 3.78 ± < 0.001 5.35 ± 2.12 3.76 ± < 0.001
2.25 2.67 2.64 2.64
Average time per day spent walking (M, SD), 63.48 ± 40.75 ± < 0.001 60.04 ± 40.84 ± < 0.001 60.5 ± 40.83 ± < 0.001
mins 38.66 38.05 38.65 38.7 38.66 38.6
Number of days per week doing resistance 1.86 ± 1.52 ± 2.1 < 0.001 1.12 ± 1.79 0.96 ± < 0.001 1.22 ± 1.85 1.04 ± < 0.001
training 2.09 1.82 1.87
Number of days per week spent doing exercises 1.27 ± 1.1 ± 1.98 < 0.001 1.55 ± 2.11 1.45 ± 0,002 1.51 ± 2.11 1.41 ± 0.001
such as gymnastics, yoga 2.12 2.17 2.15
Meeting PA Guidelines, %
≥150mins/week MPA or 45.7% 31.1% < 0.001 35.0% 20.8% < 0.001 36.4% 22.2% < 0.001
≥75mins/week VPA or 56.7% 39.9% < 0.001 45.5% 29.7% < 0.001 47.0% 31.0% < 0.001
Combination of MVPA 78.0% 57.9% < 0.001 66.0% 47.3% < 0.001 67.6% 48.8% < 0.001
Muscle strength. Activities ≥ 2 days/week 57.9% 47.3% < 0.001 52.2% 44.2% < 0.001 53.0% 44.6% < 0.001
PA Physical activity, MPA Moderate-intensity physical activity, VPA Vigorous- intensity physical activity, MVPA Moderate- and vigorous intensity physical activity
VPA, in MPA and in walking included an increase in digital or online resources (β = 0.4, 95%CI 0.2 to 0.6), be-
number of days with sleep problems (β = − 28, 95%CI − ing able to participate in simple calisthenics at home
41 to − 15; β = − 42, 95%CI − 59 to − 29; and β = − 83, (β = 1, 95%CI 0.8 to 1.3), and having access to a home
95%CI − 104 to − 62, respectively), closure of fitness gym (β = 0.9, 95%CI 0.5 to 1.2). Following self-isolation
centre/gym (β = − 99, 95%CI − 116 to − 84; β = − 77, recommendations (β = − 0.6, 95%CI − 0.8 to − 0.3) and
95%CI − 96 to − 59; and β = − 41, 95%CI − 66 to − 15, re- having access to a home gym (β = − 0.1, 95%CI − 0.4 to
spectively) and not being able to leave the house for PA 0.2) were associated with a greater reduction in the
(β = − 93, 95%CI − 109 to − 78; β = − 123, 95%CI − 141 number of days per week participants reported not get-
to − 105, and β = − 217, 95%CI − 243 to − 192, respect- ting enough sleep. In contrast, having children under 18
ively). Factors associated with a smaller decline in mi- years of age in the residence (β = 0.4, 95%CI 0.2 to 0.6)
nutes per week in VPA and MPA included using digital and not being able to leave the house for PA (β = 0.2,
or online resources (β = 19, 95%CI 5 to 33 and β = 23, 95%CI 0.02 to 0.4) were associated with a smaller reduc-
95%CI 7 to 38, respectively) and having access to a home tion in the number of days per week participants re-
gym (β = 38, 95%CI 15 to 62 and (β = 33, 95%CI 7 to 60, ported not getting enough sleep.
respectively). Factors associated with a greater decline in Associations between meeting WHO Global PA and
days per week participating in muscle strengthening ac- muscle-strengthening recommendations and selected
tivities included closure of fitness centre/gym (β = − 99, COVID-19 factors are reported in Table 4. Compared
95%CI − 116 to − 84) and not being able to leave the with those who did not use online PA resources, those
house for PA (β = − 93, 95%CI − 109 to − 78). Factors as- who did were 1.4 (95%CI 1.3, 1.5) and 1.9 (95%CI 1.8,
sociated with a smaller decline in days per week partici- 2.1) times more likely to meet the recommendations for
pating in muscle strengthening activities included using PA and for muscle-strengthening activities, respectively.Kontsevaya et al. BMC Public Health (2021) 21:893 Page 7 of 12
Table 3 Associations between changes in time spent in physical activity and sleep and selected COVID-19 factors
Change (In the last 7 days minus Before COVID-19)
Mins per week Mins per week Mins per week Days per week Days per week
VPA MPA walking muscle not getting
strengthening enough sleep
activities
β 95% CI β 95% CI β 95% CI β 95% CI β 95% CI
Had children U18 living with you −0.64 −1.28, 0 −0.74 −1.48, 0 − 0.2 − 1.22, 0.82 − 0.01 − 0.02, 0.414 0.25,
0.01 0.58
Followed self-isolation recommendation 4.02 −15.96, − −36.99, −84.01 − 115.73, 0.09 − 0.22, − − 0.82, −
23.99 13.94 9.11 −52.29 0.4 0.555 0.29
Owned a pet dog − 0.36 −1.56, − 0.83 −2.22, − 0.9 −2.81, 1.02 −0.01 − 0.03, −0.002 − 0.21,
0.85 0.56 0.01 0.20
Had access to the outside 0.99 −0.01, 0.64 −0.53, 1.8 0.59 −1.01, 2.19 −0.001 −0.02, − −0.44,
2.00 0.01 0.151 0.14
Had access to a “green space” −0.38 −1.10, −0.33 − 1.17, − 0.6 − 1.74, 0.54 0.004 −0.01, − −0.29,
0.34 0.5 0.015 0.098 0.09
Had increase in number of days per week with −28.10 −41.09, − −44.32 −59.31, −82.90 − 103.53, −0.03 − 0.23, 1.302 1.13,1.47
sleep problems 15.11 29.34 −62.27 0.17
Used digital or online PA resources 18.85 5.16, 22.62 6.81, 8.28 −13.48, 0.42 0.21, −0.44 −0.62, −
32.55 38.42 30.03 0.63 0.26
Followed at least two relevant preventive 12.79 −17.99, 6.80 −28.72, −28.21 −77.10, 0.29 −0.19, −0.091 − 0.49,
measures from Ministry of Health 43.57 42.32 20.67 0.76 0.31
Fitness centre/gym closed −99.56 −115.61, − −95.55, −40.74 −66.23, − −1.36 − 1.61,- 0.044 −0.16,
−83.51 77.03 −58.50 15.24 1.11 0.25
Couldn’t leave the house for PA −93.41 −109.21, − −140.98,- −217.48 − 242.56, −1.25 − 1.49, 0.231 0.02,0.44
− 77.62 122.75 104.53 − 192.39 − 1.01
Able to participate in calisthenic activities at 19.42 2.80, 1.30 −17.89, −21.92 −48.33, 1.07 0.82, −0.473 − 0.69, −
home 36.05 20.48 4.48 1.33 0.256
Had a home gym 38.46 15.33, 33.24 6.54, −20.68 −57.42, 0.88 0.53, −0.134 −0.43,
61.59 59.93 16.05 1.24 0.17
Live in a Metropolis/city −16.46 −43.23, −8.36 −39.25, −5.12 −47.63, −0.13 −0.54, − −0.43,
10.30 22.52 37.38 0.28 0.081 0.27
Live in a flat/apartment −11.70 −27.92, −25.95 −44.67, −38.44 −64.19, − 0,01 − 0.24, − −0.34,0.1
4.51 −7.24 12.68 0.26 0.123
Live in urban area (population) 15.18 − 12.38, 3.33 −28.49, − 12.29 − 56.06, 0.07 −0.36, −0.337 − 0.70,
42.74 35.13 31.48 0.49 0.02
All analyses adjusted for sex and age
PA Physical activity, MPA Moderate-intensity physical activity, VPA Vigorous-intensity physical activity
Compared with those who did not have access to a significantly declined compared with pre-COVID levels.
green space, those who did were more likely to meet the Not being allowed to leave the house for PA and the
PA (OR = 1.2, 95%CI 1.1, 1.2) and muscle strengthening closure of fitness centres were policies associated with
(OR = 1.1, 95%CI 1.1, 1.2) recommendations. Those who greater declines in PA and sleep. Conversely, those indi-
owned a pet dog (OR = 1.2, 95%CI 1.1, 1.3) and those viduals who could access a green space or who partici-
who followed the self-isolation rules (OR = 1.3, 95%CI pated in activities at home – using online resources or
1.2, 1.4) were more likely to meet the PA and muscle with the necessary equipment – showed much smaller
strengthening recommendations, respectively, than those declines in PA and sleep. In addition, we found that
who did not. Conversely, compared with their urban those who lived in apartments and in rural areas were
counterparts, rural adults were less likely to meet the PA more likely to be adversely affected in terms of their par-
recommendation (OR = 0.9, 95%CI 0.8, 0.9). ticipation in PA.
In our study the number of days per week that partici-
Discussion pants got enough sleep decreased while the number of
We found that as a result of COVID-19 restrictions in days per week that participants had trouble falling asleep
Russia, there were perceptions among adults that their increased. These results are consistent with studies in
participation in PA and their sleep duration had China [27], and Italy [28, 29] showing the negativeKontsevaya et al. BMC Public Health (2021) 21:893 Page 8 of 12
Table 4 Associations between meeting WHO Global PA Recommendations and selected COVID-19 factors
Meeting PA Recommendation (150mins/week MPA or Meeting muscle-strengthening activities recommendation
75mins/week VPA) (≥2 days/week)
% OR (95%CI) % OR (95%CI)
Follow self-isolation recommendation
No (ref) 88.0% 0.95 (0.85–1.05) 92.2% 1.28 (1.17–1.4)
Yes
Own a pet dog
No (ref) 32.5% 1.23 (1.13–1.33) 27.3% 1.04(0.95–1.12)
Yes
Had access to outside
No (ref) 92.8% 1.12 (1.01–1.24) 91.2% 0.99 (0.87–1.12)
Yes
Had access to a green space
No (ref) 75.4% 1.17 (1.09–1.24) 73.7% 1.14 (1.06–1.23)
Yes
Had increase in number of days per week with sleep problems
No (ref) 66.1% 0.88 (0.83–0.94) 62.9% 0.95 (0.88–1.02)
Yes
Used digital or online PA resources
No (ref) 47.0% 1.40 (1.3–1.51) 52.0% 1.93 (1.75–2.13)
Yes
Following at least two relevant preventive measures from Ministry of Health
No (ref) 4.2% 1.00 (0.86–1.17) 4.6% 1.08 (0.89–1.30)
Yes
Geographic location
Urban (ref) 25.7% 0.89 (0.82–0.96) 23.6% 0.95 (0.87–1.04)
Rural
Live in a flat/hostel
No (ref) 61.1% 0.8 (0.74–0.87) 65.5% 0.91 (0.84–0.98)
Yes
All analyses adjusted for sex and age
PA Physical activity, MPA Moderate-intensity physical activity, VPA Vigorous- intensity physical activity
impact of COVID-19 home confinement on sleep, but in We found that the restrictions during COVID may
contrast with Spanish survey where overall duration of have been associated with a reduction in number of days
sleep increased without worsening its quality [17]. In per week and number of hours per day spent in PA and
Russia, COVID-19 upended daily routines in a number a reduction in all types of activities. It is important to
of ways: more people were working from home, meals note that the number of days participating in resistance
times were altered, SB – especially screen time – in- or strength training also decreased significantly as did
creased. These factors, in addition to the social distan- the proportion who met the 2020 WHO recommenda-
cing requirements, likely resulted in a disruption to tion to do muscle-strengthening activities on at last 2
circadian rhythms [30]. Home confinement is associated days per week. During home confinement, such activities
with reduced levels of PA which, in addition to the social can be performed using digital or online resources,
isolation, may increase stress levels and disrupt night- which we found was positively associated with a higher
time sleep. Physiological factors such as reduced sunlight number of days per week of muscle strengthening activ-
exposure and weaker light–dark cycles as a result of less ities. Despite an increased offering of digital or online re-
time spent outdoors may also have affected sleep and sources that could be accessed at home, participants
circadian rhythms [31]. perceived that they were not able to maintain theirKontsevaya et al. BMC Public Health (2021) 21:893 Page 9 of 12 normal pre-COVID PA levels. Those who did take up To the best of our knowledge, this is the first pub- the offering and use such resources were more likely to lished study to report on PA and sleep among Russian meet PA recommendations. More support needs to be adults during the COVID-19 pandemic. Another inter- provided to those who were not able to access these re- national online survey on PA had similar findings but sources, which may have been exacerbated by the higher did not include participants from the Russian Federation increased levels of stress and uncertainty. [11]. Other studies from Australia [10], Poland [38], Providing opportunities for PA is important in Spain [12], Greece [13] reported similar reductions in building strong immune systems and reducing the PA and increases in SB during lockdown in adults. In susceptibility to infection. A recent study using Men- United Kingdom survey 35% participants reported less delian randomization demonstrated that higher levels than before exercising, but 49% more than before [14]. of PA was associated with a lower probability of be- There is a need to address the impact of COVID-19 ing admitted as an outpatient for COVID-19 [32]. on healthy levels of movement behaviours and subse- Conversely, a decline in PA in patients with a chronic quent NCD risk, including using modern technologies noncommunicable disease increase both the risk of (on-line) as part of a suite of strategies [39]. To prevent COVID-19 as well as the risk of cardiovascular and the unintended consequences of COVID-19 restrictions other adverse events [33]. and ‘stay home’ advice on PA and sleep – and as a corol- However, the extent to which changes in PA participa- lary mental and social health, a balance is needed be- tion may be associated with the COVID-19 pandemic is tween preventing the spread of infection and providing dependent upon the confinement policies of individual opportunities for people to participate in healthy levels governments. For example, in China different policies at of movement behaviours. regional levels was associated with differences in PA par- Our results can be used to further research and devel- ticipation [34]. opment in public health promotion in Russia during the We found that a perceived increase in sleep problems COVID-19 pandemic. Health promotion campaigns was associated with a perceived greater decline in PA aimed at informing the population about the risks of and less likelihood to meet the PA guidelines. This physical inactivity are recommended. Evidence also sug- reinforces how PA and sleep are interrelated, which is gests that web -[39] and app-based [40] interventions consistent with evidence from systematic reviews dem- that people can access in their home might be especially onstrating the association between sleep and exercise. beneficial if participants are motivated to adhere to the Exercise promotes increased sleep efficiency and dur- requirements. Some technology and social media have ation regardless of the mode and intensity of activity, es- used gamification to overcome challenges in adherence, pecially in populations suffering from disease [35]. fitness influencers on Instagram can be one of the We identified several factors that were associated with drivers of increasing PA [41]. Further enhancements healthier levels of PA and sleep habits during COVID- such as providing opportunities for social interaction 19. These suggest that the impact of the pandemic has should also be considered. not been uniform among Russian adults. People living in urban area were less likely to achieve the PA recommen- Limitations dations, which is consistent with findings from before While there are a number of strengths of the present the pandemic and demonstrates that those living in study, such as the large sample size, and the timing of urban areas are more active that their rural counterparts data collection relative to lockdown restrictions in [21]. Living in a detached house, owning a dog, having a Russia, there are a number of limitations. First, our study home gym were all favorably associated with healthy was cross-sectional meaning participants perceived the movement behaviours. In addition, having access to a changes in their PA and sleep from before to during green space was positively associated with PA. This in- COVID-19. As such, participants may have been more formation may be helpful to policymakers of population likely to overstate the changes in PA and sleep in the ab- sub-groups who are at highest risk of being inactive sence of any true baseline data. Second, all data were during COVID in potentially informing what should be self-reported and subject to recall bias such as overesti- considered when planning a response to provide oppor- mation of time spent in PA and in sleep. Although the tunities to be active while at the same time adhering to sleep questions were modified from questions found in social distancing requirements. Participants living in a other questionnaires [42–44], these items were not able house versus an apartment may have easier access to to be validated in a Russian population before the survey front or back yards for outdoor play and PA [36]. Fam- was administered during the initial stage of COVID-19. ilies who had a dog had higher PA and outdoor time. A They also only ask about one aspect of sleep quality and recent systematic review also showed that dog-related insomnia, namely difficulty in falling asleep and in get- interventions increased PA [37]. ting enough sleep. Other aspects related to insomnia
Kontsevaya et al. BMC Public Health (2021) 21:893 Page 10 of 12
and sleep quality would provide a more detailed descrip- be made for high risk groups such as older adults and
tion of the impact of COVID-19 on these important as- people living with chronic diseases.
pects of sleep. Third, our sample included an under- Future studies should also evaluate the longer-term as-
representation of males, which although unfortunate is sociations between the COVID-19 virus outbreak and
consistent with other COVID-19 survey research among recovery on PA, sedentary and sleep behaviours. To de-
adults [10, 13, 14, 38]. As such, these data may not be velop targeted health promotion strategies in Russia, it
reflective of males living in Russia. In our opinion this would be useful to identify province-specific or geo-
survey can be generalized to some groups in the Russian graphic differences influencing health behaviours.
population, predominantly women of young and middle
age from five regions who actively use Internet (Tver, Abbreviations
COVID-19: Coronavirus Disease 2019; WHO: World Health Organization;
Tatarstan, Irkutsk, Sakhalin, and Bashkortostan). This PA: Physical activity; MPA: Moderate physical activity; VPA: Vigorous-intensity
group could be a target for any or web- or app-based in- physical activity; SB: Sedentary behaviour
terventions to promote healthy levels of PA and sleep
considering that it will likely impact not only on them Supplementary Information
but potentially to members of their families, children The online version contains supplementary material available at https://doi.
org/10.1186/s12889-021-10946-y.
and male partners. Fourth, we adjusted for sex and age
but not for other covariates such as socioeconomic sta-
Additional file 1. Questionnaire.
tus in the analyses. Finally, during the COVID-19 out-
break, the main instruments used to investigate
perceived changes in PA and sleep habits were on-line Acknowledgements
We would like to acknowledge Ekaterina Ivanova, Loubov Drozdova, Marina
surveys [11, 45]. This method has limitations but was Popovich for their input in the survey development as well as chief
the preferred method available during this period, being specialists in preventive medicine of the regional Ministries of health for help
easier to collect data compared with a telephone survey. with survey promotion in the regions of the Russian Federation, especially
Alla Solovjeva (Tver), Elena Slolyarova (Sakhalin), Ilnur Khalfiev (Tatarstan) and
Online research is therefore a recommended approach if Alexander Seledtsov (Irkusts).
the aim is to reach a large group of participants in a
short period of time, ensuring their safety under pan- Authors’ contributions
AK, DM, AM analyzed the data, conceived the manuscript. AK, DM, AM, AO,
demic conditions [46].
OD contributed to the interpretation of the data and the discussion of the
results. AK and DM wrote the manuscript, and all the authors reviewed it. All
authors read and approved the final manuscript.
Conclusion
Funding
Results of on-line cross-sectional surveys can be import- No specific funding was received for writing this article.
ant to guide the development of interventions aimed to
improve negative lifestyle behaviours associated with Availability of data and materials
COVID-19 confinement. Health promotion strategies di- All data generated or analysed during this study are included in this
published article [and its supplementary information files].
rected at promoting positive health-related behaviors
should be introduced to counter the negative impact of Declarations
the pandemic. Ongoing evaluation of the impact of dif-
ferent levels of restrictions – which will be present in Ethics approval and consent to participate
The study protocol was approved by the Ethics Committee of the National
some jurisdictions for an extended period of time – on Medical Research Centre for Therapy and Prevention of the Ministry of
health behaviors is necessary to inform these targeted health of Russian Federation (approval N 03–04/20, 24 April 2020).
health promotion strategies. Healthy levels of PA and Written informed consent was obtained from participants via their online
participation.
sleep also affect the immune system through promoting All methods were carried out in accordance with relevant guidelines and
healthy circadian rhythms and as such might serve as a regulations.
protective strategy against infectious diseases.
This study has implications for policymakers in Russia. Consent for publication
Not applicable: this manuscript does not contain any personal data from
It demonstrates the need for efforts to stimulate wider participants.
use of on-line resources for PA, and to consider the pos-
sibility of re-opening gyms and fitness centres, with all Competing interests
possible safety contingencies, during the period of re- The authors declare that they have no competing interests.
strictions. Local councils should consider the importance Author details
of providing access to green spaces as part of their 1
Department of Public Health Promotion, National Medical Research Centre
COVID-19 policies, especially if accompanied by infec- for Therapy and Preventive Medicine of the Ministry of Health of Russia, Bld.
10, Petroverigskiy Lane, Moscow 101990, Russia. 2Early Start and Illawarra
tion control measures such as social distancing and Health & Medical Research Institute, University of Wollongong, Wollongong,
wearing face masks. Special considerations should also NSW, Australia.Kontsevaya et al. BMC Public Health (2021) 21:893 Page 11 of 12
Received: 28 November 2020 Accepted: 22 April 2021 18. Al-Ajlouni YA, Park SH, Alawa J, et al. Anxiety and depressive symptoms
are associated with poor sleep health during a period of COVID-19-
induced nationwide lockdown: a cross-sectional analysis of adults in
Jordan. BMJ Open. 2020;10:e041995. https://doi.org/10.1136/bmjopen-2
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